What does placental presentation on the anterior wall of the uterus mean and what does it affect?
The placenta is a unique organ that appears in a woman’s body only during pregnancy. Its main purpose is to connect the fetus with the maternal organism and supply it with all the substances necessary for development. The placenta begins to develop from the first week of pregnancy, and its full formation ends at a period of 15-16 weeks. From where the egg is located during fertilization, it will depend on where the “baby seat” is attached. As a rule, it is the posterior or anterior wall of the uterus. Basically it is believed that the first option is optimal for the development of the baby. If the diagnosis is “placenta on the front wall”, then during pregnancy there may be some difficulties. Although in most cases it does not affect the process of carrying a child or natural birth.
Risks of this pathology
If the placenta is located on the front wall of the uterus, then it can cause the following complications:
- Premature detachment. This situation may be due to the fact that the front wall has the property of strong stretching. In addition, it is much thinner than the back. At the same time during movement of the fetus or even when stroking the abdomen, a contraction of the uterus can occur, which leads to an increase in its tone, which causes the placenta to detach. This is especially true for the later periods, when the baby moves very actively. Premature detachment can lead to profuse blood loss and miscarriage. With untimely care there is a high probability of death for both mother and fetus.
- The placenta on the anterior wall of the uterus is one of the complicating factors during cesarean section surgery. The fact is that when it is carried out, the incision is made exactly where the children's place is located, and this can lead to abundant blood loss. Therefore, before surgery, doctors carefully study the location of the placenta.
- If the placental layer is located in the inner throat, the risk of a low location of the children's place increases: this pathology can cause bleeding.
- Difficulties in listening to the fetal heartbeat with a stethoscope — all sounds become less distinct.
- The placenta on the front wall may be the reason that the expectant mother may not feel for a very long time the movements of the fetus.
Who is affected by this pathology?
As a rule, the placenta is attached to the front wall of multiparous women. Indeed, with each subsequent pregnancy, the muscle fibers of the uterus stretch more and more. This particularly applies to the anterior uterus, and this explains the possible risks of this pathology.
Placenta on the front wall: diagnosis
The location of the baby seat can be found only as a result of modern ultrasound, which expectant mothers should undergo at least 3 times during the entire pregnancy. The placenta has been well visualized since the 14th week.
What it is?
To ensure the life of the chorion, and in the future, and the fetus necessarily require full blood flow. The baby can get all the nutrients and oxygen through the uteroplacental artery system. They pass through the placenta in large numbers, ensuring the growth and development of the fetus.
The main function, which is laid by nature in placental tissue, is to provide the fetus with nutritional components, as well as its protection from external influences. The intrauterine development of the fetus depends on how the placenta is located. At a certain period of pregnancy, the movement of the fetus will help determine the growth rate of the fetus.
The intensity of the intrauterine development of the baby depends on how the placenta is attached. Attachment of placental tissue is determined, in fact, from the first weeks of pregnancy. The location of the implantation of a fertilized egg affects where the placental tissue will be located.
The placenta is most often located on the back of the uterus in the area of its bottom. In some cases, it can be located in the side walls either right or left. If there is a lot of placental tissue, then it can be attached at once to several uterine walls.
This physiological location of the placenta is explained quite simply. Blood supply in the area of the uterus and its posterior wall is quite well expressed. This helps the fetus to grow quickly and intensively.
Obstetricians and gynecologists note that in some cases the placenta can be attached to the front wall of the uterus. It should be noted that this occurs much less frequently.
Normal attachment of the placenta on the back wall due to nature is not accidental. Such an arrangement is more beneficial for fetal development.
Placental tissue can be attached in different parts of the uterus. So, most often it is attached in the bottom area. However, under certain conditions, the insertion of placental tissue occurs below - in the region of the lower segment of the uterus. Too low location of the placental tissue is fraught with the development of its presentation.
Doctors consider the pathology of the placenta to be pathology when the placental tissue is in close proximity to the internal uterus. Normally, there is a certain distance between them. So, in the 2nd trimester, the placental tissue is normally higher than the internal pharynx by 5 cm. If this distance is significantly reduced, then this pathological condition is called previa.
Doctors distinguish several clinical variants of placental tissue presentation. So, placenta previa can be central, marginal or lateral. Different clinical variants of this pathology are caused by the placental tissue attached to which wall.
Why is this happening?
The attachment of the placenta to the anterior wall of the uterus is due to the very early stages of pregnancy. It happens quite simply. Fertilized egg for some reason can not attach to the bottom of the uterus and begins to fall below. So it goes down almost to the internal pharynx, where its implantation takes place.
Various gynecological diseases can contribute to the development of anterior presentation of the placenta. Chronic inflammation that occurs in the reproductive organs of a woman leads to their damage. In this case, the mucous membrane lining the inner surface of the uterus changes. Such changes and contribute to the fact that a fertilized egg can be attached in the lower sections.
The placenta can be attached to the anterior wall of the uterus even if the woman has undergone a series of gynecological operations. Thus, scraping or the consequences of surgical abortions can contribute to the development of this type of presentation.
Doctors note that the risk of placenta prevalence is slightly higher in multiparous women. If at the same time a woman has a burdened obstetric and gynecological history, then the probability of anterior presentation of placental tissue increases several times.
Various congenital abnormalities of the reproductive organs can also contribute to the development of this pathology. Placenta previa can occur in women with uterine hypoplasia. Anatomical defects in the structure of the uterus can also contribute to the development of this pathology.
Features of this location
Attachment of placental tissue on the front wall is less physiological. Such an arrangement of placental tissue has both minuses and advantages. The benefits are much less than the minuses.
It should also be noted that such a clinical situation requires a certain medical approach. For a pregnant woman who has such an arrangement of the placenta, rather careful supervision by doctors is required.
The advantages of anterior placenta previa include the possibility of migration. During several months of waiting for a baby to be born, placental tissue can change its position. Doctors note that placental tissue with anterior previa placenta is much easier to shift than the posterior.
It is noted that the placenta is extremely rarely attached to the anterior wall of the uterus. This feature is of great biological importance. This is explained quite simply. Placental tissue is very delicate. It can be easily damaged due to various external traumatic effects.
The location of the placenta on the anterior wall of the uterus can be dangerous development of its detachment. In this case, abdominal injuries can contribute to the development of dangerous uterine bleeding. If it is too intense, then in such a situation an acute oxygen starvation of the fetus can develop, which means that there will be a strong threat to the life of the baby.
Is migration of the placenta possible?
Migration is the change in the original location of the placenta. Experts believe that a change in the localization of placental tissue with prevalence on the front wall is possible. This is usually warned pregnant women and doctors when referring to them for advice.
When detecting placenta prevailing in the front wall in early pregnancy, the expectant mother should not panic first of all. Before the onset of labor is still quite far away. During this time, the placental tissue can shift and even significantly change its position.
Such changes are evaluated through ultrasound. As a rule, physicians prescribe several consecutive ultrasound examinations to track the dynamics. With the presentation of placental tissue, vaginal examinations are often not necessary. The lower is the placenta, the higher the likelihood of damage. Tracking the dynamics of the location of the placental tissue with previa is very important. It helps doctors to identify developing complications in a timely manner and take the necessary measures to improve the situation.
It should be noted that in most cases the placental tissue changes its position rather slowly. Optimally, if this process will occur in the female body within 6-10 weeks. In this case, the likelihood that the expectant mother will have any pronounced discomfort symptoms is quite low. Usually, the migration of placental tissue is completely completed by the middle of the third trimester of pregnancy.
In case the placental tissue is displaced too quickly for some reason, adverse symptoms may occur. The most dangerous of them are the development of bleeding and detachment of placental tissue from the uterine wall. As a rule, adverse symptoms develop if migration of the placenta occurs within 1–2 weeks. The rate of migration of the placenta depends on many factors and reasons, including how high the placental tissue was originally located.
When pregnancy occurs with the development of anterior placenta previa, various surprises can be expected. Usually adverse symptoms begin to develop from the 2nd trimester of pregnancy. The course of the 3rd trimester can also be complicated by the development of a number of pathologies.
Expectant mothers should remember that presence of placenta previa is not a sentence for the birth of a healthy baby. This pathology has already encountered quite a few women who have given birth to their long-awaited healthy babies.
It is important to remember that such a “special” pregnancy requires only a more attentive attitude of the future mother to her health, as well as close monitoring of the course of intrauterine development of the fetus by specialists.
With a low location of the placenta and its presentation of the most dangerous complication is, perhaps, the development of bleeding. If it is strong enough, it does not go unnoticed. In this situation, the woman notices the appearance of blood from the genital tract. The severity of bleeding can be different, the color of blood varies from bright red to dark brown. In this situation, the main thing is to remember that when such bleeding occurs, women with placenta previa should immediately consult an obstetrician-gynecologist.
Placental abruption is another complication that can develop during such a pregnancy. The severity of the resulting disturbances in this case depends largely on how much the placenta has exfoliated from the uterine wall.
If this area is small, then it is possible to identify the detachment only through ultrasound. In this case, the woman may not even appear bleeding from the genital tract, or they will be so insignificant that they will be ignored.
What is the placenta
The placenta is a unique organ that appears only during the period of pregnancy, and after the birth of the baby, it leaves naturally through the birth canal. It is the placenta that connects the organisms of the mother and the baby, providing the fetus with everything necessary.
Fully this body is formed only by 15–16 weeks of pregnancy. That is why the first weeks, when there is no placenta yet, are the most dangerous for the fetus.
The placenta does not contain nerve cells, and therefore is not connected with either the brain or the spinal cord of the future mother. Thus, it is the only organ that works completely autonomously - without control from the maternal organism.
Functions of the placenta
The placenta is designed to perform a number of functions that ensure the vital activity and proper development of the fetus. These include:
- delivery of nutrients to the baby,
- excretion of metabolic products from the children's body,
- gas exchange - delivery of oxygen and removal of carbon dioxide,
- filtration of harmful substances entering the mother’s blood,
- protection from mom's immune cells, which recognize the fetus as a foreign element and try to “attack” it,
- hormone synthesis - hCG (which is an indicator of pregnancy when using tests), prolactin and others responsible for the growth and development of the child.
Types of location of the placenta
At the place of attachment in the uterus determine the following types of location of the placenta:
- on the back or front wall
- closer to the bottom of the uterus or to the entrance to it. The placenta can be located both on the front and on the back wall of the uterus
The optimal position of the placenta is closer to the bottom of the uterus on the back wall.
And if the location that closes the entrance to the uterus is called partial or full placenta previa and requires a cesarean section, then the attachment of the fetus on the front wall is not so dangerous pathology and is not considered an indication for operative delivery.
Causes of anterior placenta attachment
Attaching an egg to the anterior wall of the uterus may not have obvious reasons, being a matter of chance. But more often specific factors contribute to the wrong location of the baby:
- endometriosis defects caused by endometriosis and other inflammatory processes,
- myoma of the uterus,
- egg features,
- multiple pregnancy, Multiple pregnancy is one of the reasons for placenta attachment along the front wall of the uterus
- the presence of scars and adhesions in the uterus and fallopian tubes,
- previous abortions
Thus, if any negative changes are present in the uterus, the egg cell chooses the safest and most optimal place in these conditions - along the front wall.
Risks of attaching the placenta to the front wall
Despite the fact that today the frontal attachment of the placenta is considered to be one of the variants of the norm and requires only special observation, this state has its own “pitfalls”. They are primarily due to the fact that the placenta does not tend to stretch. But it is the anterior wall of the uterus that changes during the growth of the fetus. Blood is one of the symptoms of incipient placental abruption.
Possible complications of attachment of the placenta to the front wall include the following pathologies:
- downward movement of the placenta. When the growing uterus dramatically expands, the placenta can begin to move to preserve integrity. If this organ migrates to a distance of less than 4 centimeters from the fallopian pharynx, there will be a problem of placenta previa,
- detachment. It is observed in conjunction with the insufficiency of the placenta and is a dangerous condition that requires immediate hospitalization and, possibly, emergency delivery,
- bleeding. It is a consequence of active movements of the fetus at the front attachment. It is fraught with hypoxia and even death of the child, therefore at the first signs of bleeding it is necessary to call an “emergency room”,
- ingrowth of the placenta. Too strong attachment is dangerous because after the birth of the baby, the placenta cannot naturally disappear and curettage is required.
Symptoms of localization of the placenta on the front wall
There are several indirect signs that indicate a possible front attachment:
- lower intensity of fetal perceptions compared with the posterior insertion, felt by the mother,
- difficulties in listening to fetal heartbeats during a physical examination,
- big belly size.
These signs can be observed in other cases. For example, a large belly also indicates a large fruit, the presence of two or more fruits, polyhydramnios.A heartbeat can be badly bugged due to the cardiovascular pathologies of the child. That is why the most informative way to determine the type of attachment of the placenta is ultrasound diagnosis.
More pronounced symptoms may occur with the onset of complications. So, in the process of moving the placenta down or during its detachment, the expectant mother often observes the following states:
- pain in the lower segment of the abdomen pulling nature, as well as a feeling of heaviness,
- spotting brown discharge,
- bleeding of varying intensity.
The attachment of the placenta on the anterior wall of the uterus may be detected or suspected during a pelvic exam, during CTG (cardiotocography) of the fetus. But for sure its location will determine the ultrasound. Ultrasound - today is the safest and most informative method for determining the placenta attachment site
Ultrasound diagnosis will help not only to reveal the fact of anterior attachment of the placenta, but also reliably show the condition of this organ and the fetus itself - whether hypoxia has occurred, if there is no latent bleeding or incipient detachment.
That is why it is so important not to ignore a doctor's referral for an ultrasound scan, even if it is prescribed very often - a specialist can recommend conducting this examination up to 2-3 times a week. It is important to understand that the ultrasound diagnosis does not harm the emerging baby and allows you to identify problems in a timely manner.
Features of pregnancy
Future mother should:
- eliminate significant physical exertion, especially on the abdominal muscles,
- running replaced by walking at a leisurely pace,
- spend more time outdoors,
- minimize the risk of abdominal trauma as much as possible - in the winter in ice, put on non-slip shoes, hold onto handrails in vehicles,
- limit the weight of lifting weights to two kilograms,
- avoid stressful situations.
And one more thing from personal experience. Since the third trimester, it is strongly recommended to carry the exchange card of a pregnant woman with you everywhere. This applies to any pregnancy, but to the situation with such a nuance - especially. Since in the case of emergency cesarean section, the doctor simply must be aware of the anterior insertion of the placenta in order to avoid complications. And you may not be able to tell him about it (with strong fights “not before”). Therefore, be sure to place an exchange card in your handbag.
Childbirth with a placenta on the front wall
During natural childbirth, the place of attachment of the placenta, as a rule, does not matter. After the baby is born, the placenta comes next in 10–15 minutes.
The situation is more complicated with cesarean section. The fact is that an incision can be made at the place of attachment of the placenta, and this increases the risk of large blood loss. Therefore, before carrying out this operation, the doctor will carefully examine the location of the placenta and will try to minimize the risks.
I also endured a child with a diagnosis of “attachment on the anterior wall of the uterus”, which was also complicated by low placentation and increased tone. It was precisely in connection with the hyperactivity of the uterus that I was prescribed a protective regimen - not to engage in sports, more often to walk, not to lift more than 2 kg. Maybe this precautionary measure played a role, but, anyway, I didn’t have any complications. Pregnancy was absolutely normal, ultrasound showed a good condition of the fetus and placenta. Yes, I heard the baby a little later than my pregnant girlfriends - on the 19th week. And the jolts were felt weaker, although I would consider it a blessing: many of my friends, pregnant and already born, complained of painful movements - the result of the activity of the grown-up baby. I did not have this. The deliveries were performed by caesarean section for reasons other than placenta. But despite the fact that the operation was not planned, but an emergency, and the doctor did not have the opportunity to thoroughly prepare for it, the intervention was successful - my daughter was born. Without complications and without any consequences. Therefore, despite the impressive list of possible complications, I am a supporter of that point of view, which perceives the anterior attachment of the placenta as a variant of the norm.
I have 3 times the placenta was on the front wall and 1 time on the back. Not much difference caught. In the first pregnancy (the placenta was on the front wall) she felt after 20 weeks. In the following - at 17-18 weeks (my constitution and weight are normal). It is impossible to distinguish palms, heels or knees by the hairs (regardless of the location of the placenta). A stomach can walk on a later date (in my own after 30 weeks). And this arrangement is not dangerous, the heartbeat is perfectly listened.
And I have a daughter on the front wall. But I did not even think that it was bad ... They were born at 37 weeks 2900, 8/9 by Apgar. I was even glad that a little earlier. The waters themselves moved away and my daughter was born easily, and I was without seams and breaks. All is well, do not worry. See how many of us are with the front wall))))
My son was on the front. Born at 40 weeks and 1 day, EP, no saving for the entire pregnancy. In general, everything is fine. Do not wind yourself, everything will be fine. And the presentation here does not play any role.
Video: all about the placenta
Thus, the attachment of the placenta along the front wall of the uterus is a pathology, which is increasingly being considered today as a variant of the norm. But despite this optimistic approach, the expectant mother should pay special attention to her position. And then the long-awaited meeting with the baby will bring only joy and not be darkened by any worries.